Malleable paste for filling bone defects

ABSTRACT

The invention is directed toward a malleable bone putty and a flowable gel composition for application to a bone defect site to promote new bone growth at the site which comprises a new bone growth inducing compound of demineralized lyophilized allograft bone powder. The bone powder has a particle size ranging from about 100 to about 850 microns and is mixed in a high molecular weight hydrogel carrier, the hydrogel component of the carrier ranging from about 0.3 to 3.0% of the composition and having a molecular weight of about at least 10,000 Daltons. The composition contains about 25% to about 40% bone powder and can be additionally provided with BMP&#39;s and a sodium phosphate buffer.

FIELD OF INVENTION

The present invention is generally directed toward a surgical boneproduct and more specifically is a flowable gel and a malleable puttybased on demineralized allograft bone particles mixed in a fluid carriercomprising a high molecular weight viscous excipient derived from theclass of biomaterials known as hydrogels.

BACKGROUND OF THE INVENTION

Malleable putty is used to correct surgical defects that may be causedby trauma, pathological disease, surgical intervention or othersituations where defects need to be managed in osseous surgery. It isimportant to have the defect filler in the form of a stable, viscousputty to facilitate the placement of the bone growth medium into thesurgical site which is usually uneven in shape and depth. The surgeonwill take the putty on a spatula or other instrument and trowel it intothe site or take it in his/her fingers to shape the bone inducingmaterial into the proper configuration to fit the site being corrected.

Many products exist to treat this surgical need. One example isautologous bone particles or segments recovered from the patient. Whenremoved from the patient, it is wet and viscous from the associatedblood. This works very well to heal the defect but requires significantsecondary surgery resulting in lengthening the surgery, extending thetime the patient is under anesthesia and increasing the cost. Inaddition, a significant increase in patient morbidity is attendant inthis technique as the surgeon must take bone from a non-involved site inthe patient to recover sufficient healthy bone, marrow and blood toperform the defect filling surgery. This leads to significantpost-operative pain.

Another product group involves the use of inorganic materials to providea matrix for new bone to grow at the surgical site. These inorganicmaterials include hydroxyapatite obtained from sea coral or derivedsynthetically. Either form may be mixed with the patient's blood and/orbone marrow to form a gel or a putty. Calcium sulfate or plaster ofParis may be mixed with water to similarly form a putty. These inorganicmaterials are osteoconductive but are bioinert and do not absorb orbecome remodeled into natural bone. They consequently remain in placeindefinitely as a brittle, foreign body in the patient's tissue.

Allograft bone is a logical substitute for autologous bone. It isreadily available and precludes the surgical complications and patientmorbidity associated with autologous bone as noted above. Allograft boneis essentially a collagen fiber reinforced hydroxyapatite matrixcontaining active bone morphogenic proteins (BMP) and can be provided ina sterile form. The demineralized form of allograft bone is naturallyboth osteoinductive and osteoconductive. The demineralized allograftbone tissue is fully incorporated in the patient's tissue by a wellestablished biological mechanism. It has been used for many years inbone surgery to fill the osseous defects previously discussed.

It is well known in the art that for several decades surgeons have useda patient's own blood as a vehicle in which to mix the patient's bonechips or bone powder, or demineralized bone powder so as to form adefect filling paste. Blood is a useful carrier because it is availablefrom the bleeding operative site, is non-immunogenic to the patient andcontains bone morphogenic proteins which facilitate wound healingthrough new bone growth. However, stored blood from other patients hasthe deficiencies that any blood transfusion would have such as bloodtype compatibility, possibility of transmission of disease and unknownconcentration of BMP which are to a great extent dependent upon the ageof the donor.

While blood contains from forty percent (40%) to fifty percent (50%)cell mass, it is a satisfactory carrier for demineralized bone powderbecause it contains both mono- and polysaccharides which contribute tothe blood viscosity and provide the bulk viscosity to the paste createdby mixing the bone powder and blood. Specific monosaccharides in bloodare glucose at a concentration of 60-100 mg/100 ml (0.1%) andpolysaccharides such as hexose and glucosamine at approximately 0.1%.Glucuronic acid is also present at approximately 0.4-1.4 mg/100 ml(average 0.01%).

The problems inherent with using the patients blood as a carrier fordemineralized bone powder are the difficulties of mixing the same at theoperating site, the difficulty in obtaining a bone paste consistencywhich can be easily applied to the surgical area, the guesswork inmixing a usable composition at the site and the problem of having a bonepaste or gel which will promote optimum bone replacement growth, not becarried away by the body fluids at the operation site or simply fall outof the bone defect site. In an attempt to solve these and otherproblems, there have been a number of other attempts using otheralternative mixtures and compositions.

Demineralized allograft bone is usually available in a lyophilized orfreeze dried and sterile form to provide for extended shelf life. Thebone in this form is usually very coarse and dry and is difficult tomanipulate by the surgeon. One solution to use such freeze dried bonehas been provided in the form of a gel. GRAFTON®, a registered trademarkof Osteotech Inc., which is a simple mixture of glycerol andlyophilized, demineralized bone powder of a particle size in the rangeof 0.1 cm to 1.2 cm (1000 microns to 12,000 microns) as is disclosed inU.S. Pat. No. 5,073,373.

GRAFTON works well to allow the surgeon to place the allograft bonematerial at the site. However, the carrier, glycerol has a very lowmolecular weight (92 Daltons) and is very soluble in water, the primarycomponent of the blood which flows at the surgical site. Glycerol alsoexperiences a marked reduction in viscosity when its temperature risesfrom room temperature (typically 22° C. in an operating room) to thetemperature of the patient's tissue, typically 37° C. This combinationof high water solubility and reduced viscosity causes the allograft bonematerial to be “runny” and to flow away from the site almost immediatelyafter placement; this prevents the proper retention of the bone withinthe site as carefully placed by the surgeon.

These problems with GRAFTON gel have been attempted to be resolved byusing a much larger particle size of allograft bone, specificallylamellae or slivers of bone created by milling or slicing the bonebefore mixing it with the glycerol carrier. This improves both the bulkviscosity and the handling characteristics of the mixture but stillleaves the problem of the fast rate of dissipation of the carrier andsome bone due to the solubility of the glycerol carrier. The largerparticles of demineralized bone may also retard the development of newbone by the patient because the large bony lamellae do not pack as wellas the smaller grainy particles of bone. This will leave more open spaceand could lengthen the tine required to grow new bone and properly fillthe defect. Another deficiency of using the bone lamellae is that theends of the bony fragments are uneven and when packed into the surgicaldefect, leave uneven filaments of bone protruding out from the defectwhich can compromise the healing rate.

U.S. Pat. No. 5,290,558 discloses a flowable demineralized bone powdercomposition using a osteogenic bone powder with large particle sizeranging from about 0.1 to about 1.2 cm. mixed with a low molecularweight polyhydroxy compound possessing from 2 to about 18 carbonsincluding a number of classes of different compounds such asmonosaccharides, disaccharides, water dispersible oligosaccharides andpolysaccharides.

Hence, the advantages of using the smaller bone particle sizes asdisclosed in the U.S. Pat. No. 5,073,373 gel patent were compromised byusing bone lamellae in the shape of threads or filaments and retainingthe low molecular weight glycerol carrier. This later prior art isdisclosed in U.S. Pat. Nos. 5,314,476 and 5,507,813 and the tissue formsdescribed in these patents are known commercially as the GRAFTON Puttyand Flex, respectively.

The use of the very low molecular weight glycerol carrier also requiresa very high concentration of glycerol to be used to achieve the bulkviscosity. Glycerol and other similar low molecular weight organicsolvents are toxic and irritating to the surrounding tissues.Furthermore glycerol has been reported to be specifically neurotoxic andthis problem is compounded when the concentration of glycerol is at the20-95% level as disclosed in the U.S. Pat. No. 5,073,373 patent.

Another attempt to solve the bone composition problem is shown in U.S.Pat. No. 4,172,128 which discloses demineralized bone material mixedwith a carrier to reconstruct tooth or bone material by adding amucopolysaccharide to a mineralized bone colloidal material. Thecomposition is formed from a demineralized coarsely ground bonematerial, which may be derived from human bones and teeth, dissolved ina solvent forming a colloidal solution to which is added aphysiologically inert polyhydroxy compound such as mucopolysaccharide orpolyuronic acid in an amount which causes orientation when hydrogen ionsor polyvalent metal ions are added to form a gel. The gel will beflowable at elevated temperatures above 35 C. and will solidify whenbrought down to body temperature. Example 25 of the patent notes thatmucopolysaccharides produce pronounced ionotropic effects and thathyaluronic acid is particularly responsible for spatial cross-linking.Unfortunately this bone gel is difficult to manufacture and requires apremolded gel form.

U.S. Pat. No. 4,191,747 teaches a bone defect treatment with coarselyground, denatured bone meal freed from fat and ground into powder. Thebone meal is mixed with a polysaccharide in a solution of saline andapplied to the bone defect site.

Another prior art product is the formulation of demineralized allograftbone particles in collagen. Both bovine and human collagen have beenused for this application. Bovine collagen carries the risk of animmunogenic reaction by the recipient patient Recently, it has beenfound that a disease of cattle, bovine spongioform encephalopathy (BSE)is transmitted from bovine tissue to humans. Thus, bovine tissue carriesa risk of disease transmission and is not a desirable carrier forallograft tissue.

Human collagen is free of these animal based diseases. However, collagenabsorbs slowly in the human body, particularly in a bony site withusually a low degree of vascularity. The slow absorption of collagen candelay the growth of new bone and result in the formation of scar tissueat the site. This could result in a non-bony healing and a result withmuch less tensile strength.

Accordingly, the prior art as embodied in the glycerol and other carrierbase technology to deliver demineralized allograft bone to a surgicalosseous site is replete with problems and only partially addresses theproblems inherent in the correcting surgical defects.

SUMMARY OF THE INVENTION

A bone putty with a useful bulk viscosity has been achieved by using avery high molecular weight class of soluble biomaterial, hydrogel. Theuse of high molecular weight hydrogels preferably over one millionDaltons allows the achievement of a very malleable bone putty with only1-3% concentration of the hydrogel in the carrier. The balance of thecarrier formulation is a sterile saline or pure water which avoids thetoxic problems with the high concentrations of the low molecular weightorganic solvents of the prior art.

It can thus be seen that the prior art has attempted to replicateputty/gel obtained by the mixing of blood with bone particles withoutthe necessity of mixing the two together at the surgical site innon-controlled proportions and under time and space prohibitions.

The selection of high molecular weight hydrogels allows the use of thepreferred small particle size granules of demineralized allograft bone.These small particles pack better in the wound defect and absorb morequickly thereby allowing the bone defect to be remodeled into thenatural bone of the patient.

It is an object of the invention to utilize demineralized powdered bonein a particle size that is useful to achieve the malleabilitycharacteristics that maximizes the amount of bone in the formulationwithout creating a gritty, less malleable characteristic.

It is yet another object of the invention to use a calcium salt with thedemineralized bone composition to aid in healing at the bone defectsite.

It is an additional object of the invention to use a non toxic carrierfor the bone particles which will not adversely impact on the patient.

It is another object of the invention to provide a premixed boneputty/gel in an oxygen protected carrier to keep the putty/gel fromdrying out or being degraded.

It is also an object of the invention to create a bone defect materialwhich can be easily handled by the physician and does not degeneratewhen contacting blood flow at the surgical site.

DESCRIPTION OF THE INVENTION

The present invention is directed towards a demineralized bone powdercomposition to heal bone defects. The preferred embodiment of Examples Iand VIII are the best mode for the putty composition and Examples XV orXVI for the gel composition. These and other alternate embodiments ofthe invention overcome the two basic deficiencies of the glycerolcarrier and bone particle flowable compositions used in the prior art:first, the low molecular weight of glycerol; and second, the use oflarge particle or lamellae to achieve the preferred bulk viscosity. Thetypes of demineralized bone used in the invention are cortical andcortico-cancellous bone powder.

Surprisingly, the combination of the 100-420 micron particle size ofdemineralized, lyophilized, allograft bone when mixed with very lowconcentrations of these very high molecular weight hydrogels in asuitable carrier produces a malleable putty with clinically useful boneinducing properties. The malleable property permits the surgeon to shapethe quantity of bone putty or gel to exactly fit the surgical defect.Manipulation of the “lump” of bone putty may be done without it stickingto the gloves of the surgeon, behaving somewhat like a wet clay used insculpting.

The ideal carriers for the malleable putty are preferably taken fromhigh molecular weight hydrogels such as 1) Sodium Hyaluronate about7.0×10⁵-3.0×10⁶ Daltons; 2) Chitosan about 1.0×10⁵-3.0×10⁵ Daltons; 3)Dextran about 1.0×10³-1.0×10⁵ Daltons; and 4) Pluronics about7.0×10³-1.8×10⁴ Daltons; and 5) N,O-carboxymethylchitosan glucosamine(NOCC) which is an example of the class of hydrogels known asglycosaminoglycan, a hydrogel derivative about 2.0×10⁶-3.0×10⁶ Daltons .

The molecular weight of the hydrogels used in the carriers set forth inthe Examples I-XVII are: Hyaluronic acid—(1.2×10⁶ Daltons).Chitosan—(2.0×10⁵ Daltons). Dextran (40,000 Daltons, used in exampleVII) or the Pluronic block copolymers of polyethylene oxide andpolypropylene oxide; Pluronic® F127 - 9849 to 14,600 Daltons (avg. mol.wt.: 12,600 Daltons); Pluronic® F108-12,700 to 17,400 Daltons (avg. mol.wt.: 14,600 Daltons).

Demineralized, lyophilized allograft bone of particle size of about 100to about 420 microns at a concentration of about 30% to 35% w/w is mixedinto an isotonic saline solution of 2% hyaluronic acid of an averagemolecular weight of about 1.2 million Daltons and produces a highlydesirable malleable bone putty. Hyaluronic acid is generally describedas an acid mucopolysaccharide. It is envisioned that suitable amounts ofbone morphogenic proteins (BMP) can be added to either the gel or puttyat any stage in the mixing process to induce accelerated healing at thebone site. BMP directs the differentiation of pluripotential mesenchymalcells into osteoprogenitor cells which form osteoblasts. The ability offreeze dried demineralized cortical bone to transfer this bone inductionprinciple using BMP present in the bone is well known in the art.However the amount of BMP varies in the bone depending on the age of thebone donor and the bone processing. Sterilization is an additionalproblem is processing human bone for medical use as boiling, autoclavingand irradiation over 2.0 mrads is sufficient to destroy or alter the BMPpresent in the bone matrix.

Another embodiment of the invention is to induce the presence of solublecalcium at the bone defect site. This will encourage new bone growththrough the normal biochemical mechanism. Soluble calcium can beattracted to the surgical site by using a sodium phosphate buffer of pH7.2 in lieu of the isotonic saline. The phosphate buffer will attractcalcium cations to the site from the surrounding healthy bone and createan equilibrium concentration of the calcium precisely at the site ofhealing where it is most desirable to grow new bone.

Another embodiment of the invention is to create a sponge sheet orsponge mat of bone which is flexible and can be cut to shape by thesurgeon. This can be made by using a cross linked hydrogel, eitherhyaluronic acid or chitosan and suspending a high concentration of boneparticles ranging from 250-850 microns in size with up to 75% bone byweight. This is then lyophilized or freeze dried to remove the watercomponent via ice sublimation leaving behind a flexible sheet of bonesuspended in the dehydrated hydrogel matrix.

Any number of medically useful substances can be used in the inventionby adding the substances to the composition at any steps in the mixingprocess or directly to the final composition. Such substances includecollagen and insoluble collagen derivatives, hydroxy apatite and solublesolids and/or liquids dissolved therein. Also included are antiviricidessuch as those effective against HIV and hepatitis; antimicrobial and/orantibiotics such as erythromycin, bacitracin, neomycin, penicillin,polymyxin B, tetracycline, viomycin, chloromycetin and streptomycin,cefazolin, ampicillin, azactam, tobramycin, clindamycin and gentamycin.It is also envisioned that amino acids, peptides, vitamins, co-factorsfor protein synthesis; hormones; endocrine tissue or tissue fragments;synthesizers; enzymes such as collagenase, peptidases, oxidases; polymercell scaffolds with parenchymal cells; angiogenic drugs and polymericcarriers containing such drugs; collagen lattices; biocompatible surfaceactive agents, antigenic agents; cytoskeletal agents; cartilagefragments, living cells such as chondrocytes, bone marrow cells,mesenchymal stem cells, natural extracts, tissue transplants,bioadhesives, transforming growth factor (TGF-beta), insulin-like growthfactor (IGF-1): growth hormones such as somatotropin; bone digestors;antitumor agents; fibronectin; cellular attractants and attachmentagents; immuno-suppressants; permeation enhancers, e.g. fatty acidesters such as laureate, myristate and stearate monoesters ofpolyethylene glycol, enamine derivatives, alpha-keto aldehydes can beadded to the composition.

The invention can best be understood by the following examples with thepercentages being determined by weight. All examples could also be donein an aseptic environment to maintain a sterile final product.

EXAMPLES OF THE INVENTION Example I:

A malleable putty of 2% solution Hyaluronic Acid in isotonic saline with250-420 micron cortical allograft bone powder @30%.

502 milligrams of freeze dried cortical allograft bone of particle sizeranging from 250-420 microns was mixed into 1,170 milligrams of a 2%solution of sodium hyaluronate in isotonic saline. The bone component isadded to achieve a bone concentration of 30% (w/w). The solution waswell mixed and allowed to stand for 2-3 hours at room temperature toprovide a malleable putty with excellent formability properties.

Example II:

A putty of 20% Pluronic F127 with 420-850 micron cortical allograft bonepowder @50%.

519 milligrams of freeze dried cortical allograft bone of particle sizeof 420-850 microns was mixed into 518 milligrams of a 20% solution ofPluronic F127 in isotonic saline. The bone component is added to achievea bone concentration of 50%(w/w). The solution was well mixed andallowed to stand for 2-3 hours at room temperature. This provided aputty with poor formability properties.

Example III:

A putty of 20% solution of Pluronic F 108 with 420-850 micron corticalallograft bone powder @50%.

528 milligrams of freeze dried cortical allograft bone of particle sizeof 420-850 microns was mixed into 522 milligrams of a 20% solution ofPluronic F108 in isotonic saline. The bone component is added to achievea bone concentration of 50%(w/w). The solution was well mixed andallowed to stand for 2-3 hours at room temperature. This provided aputty with poor formability properties.

Example IV:

A malleable putty of 20% solution of Dextran 40PM with 420-850 microncortical allograft bone powder @33%.

502 milligrams of freeze dried cortical allograft bone of particle sizeof 420-850 microns was mixed into 1,024 milligrams of a 20% solution ofDextran 40 PM in isotonic saline. The bone component is added to achievea bone concentration of 33%(w/w). The solution was well mixed andallowed to stand for 2-3 hours at room temperature. This provided amalleable putty with moderate formability properties.

Example V:

A malleable putty of 20% solution of Pluronic F127 with 100-300 microncortical allograft bone powder @33%.

503 milligrams of freeze dried cortical allograft bone of particle sizeof 100-300 microns was mixed into 1,004 milligrams of a 20% solution ofPluronic F127 in isotonic saline. The bone component is added to achievea bone concentration of 33%(w/w). The solution was well mixed andallowed to stand for 2-3 hours at room temperature. This provided amalleable putty with excellent formability properties.

Example VI:

A malleable putty of 20% solution of Pluronic F108 with 100-300 microncortical allograft bone powder @33%.

502 milligrams of freeze dried cortical allograft bone of particle sizeof 100-300 microns was mixed into 1,006 milligrams of a 20% solution ofPluronic F108 in isotonic saline. The bone component is added to achievea bone concentration of 33%(w/w). The solution was well mixed andallowed to stand for 2-3 hours at room temperature. This provided amalleable putty with excellent formability properties.

Example VII:

A malleable putty of 20% solution of Dextran 40 PM with 100-300 microncortical allograft bone powder @33%.

502 milligrams of freeze dried cortical allograft bone of particle sizeof 100-300 microns was mixed into 1,006 milligrams of a 20% solution ofDextran 40 PM in isotonic saline. The bone component is added to achievea bone concentration of 33%(w/w). The solution was well mixed andallowed to stand for 2-3 hours at room temperature. This provided amalleable putty with excellent formability properties.

Example VIII:

A malleable putty of 3% solution hyaluronic acid with 100-300 microncortical allograft bone powder @33%.

720 milligrams of freeze dried cortical allograft bone of particle sizeof 100-300 microns was mixed into 1,402 milligrams of a 3% solution ofsodium hyaluronate in isotonic saline. The bone component is added toachieve a bone concentration of 33%(w/w). The solution was well mixedand allowed to stand for 2-3 hours at room temperature. This provided amalleable putty with excellent formability properties.

Example IX:

A malleable putty of 1% solution hyaluronic acid with 250-420 microncortical allograft bone powder @40%.

605 milligrams of freeze dried cortical allograft bone of particle sizeof 250-420 microns was mixed into 906 milligrams of a 1% solution ofsodium hyaluronate in isotonic saline. The bone component was added toachieve a bone concentration of 40% (w/w). The solution was well mixedand allowed to stand for 2-3 hours at room temperature. This provided amalleable putty with poor formability properties.

Example X:

A malleable putty of 3% solution chitosan with 100-300 micron corticalallograft bone powder @33%.

507 milligrams of freeze dried cortical allograft bone of particle sizeof 100-300 microns was mixed into 1,002 milligrams of a 3% solution ofchitosan in isotonic saline. The bone component is added to achieve abone concentration of 33%(w/w). The solution was well mixed and allowedto stand for 2-3 hours at room temperature. This provided a malleableputty with good formability properties.

Example XI:

A malleable putty of 3% solution chitosan with 420-850 micron corticalallograft bone powder @33%.

518 milligrams of freeze dried cortical allograft bone of particle sizeof 420-850 microns was mixed into 1,038 milligrams of a 3% solution ofchitosan in isotonic saline. The bone component is added to achieve abone concentration of 33%(w/w). The solution was well mixed and allowedto stand for 2-3 hours at room temperature. This provided a malleableputty with good formability properties.

Example XII:

A malleable putty of 3% solution chitosan with 420-850 micron corticalallograft bone powder @50%.

518 milligrams of freeze dried cortical allograft bone of particle sizeof 420-850 microns was mixed into 522 milligrams of a 3% solution ofchitosan in isotonic saline. The bone component is added to achieve abone concentration of 50%(w/w). The solution was well mixed and allowedto stand for 2-3 hours at room temperature. This provided a malleableputty with poor formability properties.

Example XII:

A malleable putty of 3% solution chitosan with 100-300 micron corticalallograft bone powder @50%.

518 milligrams of freeze dried cortical allograft bone of particle sizeof 100-300 microns was mixed into 522 milligrams of a 3% solution ofchitosan in isotonic saline. The bone component is added to achieve abone concentration of 50%(w/w). The solution was well mixed and allowedto stand for 2-3 hours at room temperature. This provided a malleableputty with poor formability properties.

Example XIV:

A flowable gel of 250-420 micron particle size cortical allograft bonegranules in a 1% solution of Hyaluronic Acid at a 25% (w/w) of bonecontent.

503 milligrams of allograft freeze dried cortical bone was mixed into1,502 milligrams of a 1% solution of sodium hyaluronate in isotonicsaline. The solution was well mixed and allowed to stand at roomtemperature to provide a flowable gel.

Example XV:

A flowable gel of 250-420 micron particle size cortical allograftgranules in a 1% solution of hyaluronic acid at a 30% (w/w) of bonecontent.

501 milligrams of allograft freeze dried cortical bone was mixed into1,167 milligrams of a 1% solution of sodium hyaluronate in isotonicsaline. The bone component is added to achieve a bone concentration of30%(w/w). The solution was well mixed and allowed to stand for 2-3 hoursat room temperature. This provided a flowable gel.

Example XVI:

A flowable gel of 420-850 micron particle size cortical allograftgranules in a 1% solution of hyaluronic acid at a 25% (w/w) of bonecontent.

501 milligrams of allograft freeze dried cortical bone was mixed into1,501 milligrams of a 1% solution of sodium hyaluronate in isotonicsaline. The bone component is added to achieve a bone concentration of25%(w/w). The solution was well mixed and allowed to stand for 2-3 hoursat room temperature. This provided a flowable gel.

Example XVII:

A flowable gel of 420-850 micron particle size cortical allograftgranules in a 1% solution of hyaluronic acid at a 30% (w/w) of bonecontent.

500 milligrams of allograft freeze dried cortical bone was mixed into1,166 milligrams of a 1% solution of sodium hyaluronate in isotonicsaline. The bone component is added to achieve a bone concentration of30%(w/w). The solution was well mixed and allowed to stand for 2-3 hoursat room temperature. This provided a flowable gel.

The following Table I sets forth the above noted examples in comparativeform:

TABLE I Bone mg/ Bone Particle Size Example # Ref # Carrier SolutionCarrier mg % (micron) Comments Putty/Gel I 4.2 2% HA 502 mg/1170 mg 30250-420 good putty: excellent formability II 1b 20% Pluronic F127 519mg/515 mg 50 420-850 too dry, too grainy putty: poor formability III 2b20% Pluronic F108 528 mg/522 mg 50 420-850 too dry, too grainy putty:poor formability IV 3b3 20% Dextran 40 PM 502 mg/1024 mg 33 420-850good, grainy; moderate packing putty: moderate formability capacity V1a1 20% Pluronic F127 503 mg/1004 mg 33 100-360 best; good, keeps shape;very putty: excellent formability good packing, moldability, sticky VI2a2 20% Pluronic F108 502 mg/1006 mg 33 100-300 best; good but slightlywet, good putty: excellent formability packing, sticky VII 3a3 20%Dextran 40 PM 502 mg/1006 mg 33 100-300 best putty: excellentformability VIII 7a7 3% HA 720 mg/1402 mg 33 100-300 good consistency,slightly putty: excellent formability sticky and slightly dry IX 2-6 1%HA 605 mg/906 mg 40 250-420 too grainy, very dry putty: poor formabilityX 5a5 3% Chitosan 507 mg/1002 mg 33 100-300 best putty: good formabilityXI 5b5 3% Chitosan 518 mg/1038 mg 33 420-850 good/grainy; too dry, packswell, putty: good formability too large granules XII 5b 3% Chitosan 518mg/522 mg 50 420-850 too dry, too grainy putty: poor formability XIII 5a3% Chitosan 518 mg/522 mg 50 100-300 too dry, won't hold shape; too dry,putty: poor formability not puttylike, too dry, no packing XIV 5-1 1% HA503 mg/1502 mg 25 250-420 Wet, still good consistency and flowable gelformability, very moderately grainy XV 5-2 1% HA 501 mg/1167 mg 30250-420 drier than 5-1, reasonable flowable gel formability, muchgrainier XVI 5-4 1% HA 501 mg/1501 mg 25 420-850 wet, grainy, notformable, flowable gel may be flowable XVII 5-5 1% HA 500 mg/1166 mg 30420-850 wet, formable, grainy flowable gel

In summation, it can been seen from Table I that:

A flowable gel can be made up of about 25-30% bone powder (particle sizein a range of 250-850 microns) mixed into a high molecular weighthydrogel carried in solution, such as 1% sodium hyaluronate (ExamplesXIV, XV, XVI, XVII).

A putty with good formability can be made up of about 30-40% of bonepowder (particle size in a range of 100-850 microns) mixed into ahydrogel solution, such as a 2-3% sodium hyaluronate or 3% chitosan or a20% Pluronic (Examples I, V, VI, VII, VIII, X, and XI).

Several examples of (II, III, IX, XII and XIII) of test results areincluded which did not produce either a successful flowable gel orputty. These show the limits of the concentrations of the respectiveexamples. Particle sizes below about 100 microns will absorb tooquickly.

In order to preclude oxidation degradation and loss of viscosity thecomposition should be mixed and packaged in an oxygen free environment.The mixing of the demineralized bone powder into hydrogel solution isundertaken in an enclosed sterile glove chamber with an oxygen freeenvironment such as in a nitrogen, argon or other inert gas filledchamber. The mixed malleable bone composition is then placed in asterile container such as an impervious syringe barrel or vial, sealedand placed in a sterile sealed package which is filled with an inert gasor vacuum sealed.

The principles, preferred embodiments and modes of operation of thepresent invention have been described in the foregoing specification.However, the invention should not be construed as limited to theparticular embodiments which have been described above. Instead, theembodiments described here should be regarded as illustrative ratherthan restrictive. Variations and changes may be made by others withoutdeparting from the scope of the present invention as defined by thefollowing claims:

What we claim is:
 1. A sterile malleable bone composition forapplication to a bone defect site to promote new bone growth at the sitecomprising a mixture of demineralized osteogenic osteoinductive bonepowder with a particle size ranging from about 100 to about 850 micronsin a carrier, the bone powder ranging from about 25 to about 35% of theweight of the composition, the carrier is selected from the groupconsisting of sodium hyaluronate, and chitosan andN,O-carboxymethylchitosan in water solution having a high molecularweight ranging from five hundred thousand to three million Daltons andranging from about 1.0% to about 3.0% by weight of the carrier solution.2. A malleable bone composition as claimed in claim 1 wherein saidmixture includes bone morphogenic proteins in excess of the amountnaturally occurring in allergenic bone.
 3. A malleable bone compositionas claimed in claim 1 including the addition of a calcium salt to thecarrier.
 4. A malleable bone composition as claimed in claim 1 whereinthe balance of the carrier formulation contains a sodium phosphatebuffer and having a pH of about 7.2.
 5. A malleable bone composition asclaimed in claim 1 wherein said bone powder is cortical allograft bonepowder.
 6. A malleable bone composition as claimed in claim 1 whereinsaid bone powder is corticocancellous allograft bone powder.
 7. Asterile malleable bone putty composition for application to a bonedefect site to promote new bone growth at the site which comprises a newbone growth inducing mixture of demineralized lyophilized allograft bonepowder with a particle size ranging from about 100 to about 850 micronsin a hyaluronic acid water carrier, the hyaluronic acid componentranging from above 1.0% to about 3% of the carrier solution and having amolecular weight of at least 10⁶ Daltons and a viscosity ranging from6,000 to about 275,000 cps, the bone content of the carrier ranging inweight from about 25% to about 35% total weight of the composition.
 8. Amalleable bone putty composition as claimed in claim 7 including theaddition of a calcium salt to the hyaluronic acid carrier.
 9. Amalleable bone putty composition as claimed in claim 8 wherein saidcalcium salt is calcium chloride.
 10. A malleable bone putty compositionas claimed in claim 8 wherein said calcium salt is calcium sulfate. 11.A malleable bone putty composition as claimed in claim 8 wherein saidcalcium salt is calcium phosphate.
 12. A malleable bone puttycomposition as claimed in claim 8 wherein said calcium salt is calciumhydroxyapatite.
 13. A malleable bone putty composition as claimed inclaim 7 wherein said carrier has a 2-3% hyaluronic acid concentrationwith the balance of the carrier formulation comprising saline water. 14.A malleable bone putty composition as claimed in claim 7 wherein saidcarrier has a 2-3% hyaluronic acid concentration with the balance of thecarrier formulation comprising sterile water.
 15. A malleable bone puttycomposition as claimed in claim 7 wherein said hydrogel carrier has a2-3% hyaluronic acid concentration with the balance of the carrierformulation contains a sodium phosphate buffer with a pH of about 7.2,said buffer attracting calcium and concentrating same at the bone defectsite.
 16. A malleable bone putty composition as claimed in claim 7wherein said carrier includes BMP in excess of the amount naturallyoccurring in allergenic bone.
 17. A malleable bone putty composition asclaimed in claim 7 wherein said bone powder is cortical allograft bonepowder.
 18. A malleable bone putty composition as claimed in claim 7wherein said bone powder is corticocancellous.
 19. A malleable boneputty composition as claimed in claim 7 including antimicrobial and/orantibiotics such as erythromycin, bacitracin, neomycin, penicillin,polymyxin B, tetracycline, viomycin, chloromycetin and streptomycin,cefazolin, ampicillin, azactam, tobramycin, clindamycin and gentamycin.20. A malleable bone putty composition as claimed in claim 7 includingvitamins.
 21. A malleable bone putty composition as claimed in claim 7including enzymes such as collagenase, peptidases and oxidases.
 22. Amalleable bone putty composition for application to a bone defect siteto promote new bone growth at the site comprising a new bone growthinducing demineralized lyophilized allograft bone powder with a particlesize ranging from about 100 to about 420 microns in a high molecularweight sodium hyaluronate and water carrier, the bone content of thecomposition ranging from about 30% to about 35% by weight and the highmolecular weight sodium hyaluronate component ranges from about 2% toabout 3% of the carrier and has a molecular weight greater than onemillion Daltons.
 23. A sterile malleable bone putty composition forapplication to a bone defect site to promote new bone growth at the sitewhich comprises a new bone growth inducing compound of demineralizedlyophilized allograft bone powder with a particle size ranging fromabout 100 to about 420 microns in a N,O-carboxymethylchitosan watercarrier solution, the N,O-carboxymethylchitosan component ranging fromabout 1.0% to about 3% of the carrier weight and having a molecularweight ranging from 2.0×10⁶-3.0×10⁶ Daltons.
 24. A malleable bone puttycomposition for application to a bone defect site to promote new bonegrowth at the site which comprises a new bone growth inducingdemineralized lyophilized allograft bone powder with a particle sizeranging from about 100 to about 850 microns in a high molecular weightchitosan water carrier solution with the bone content of the puttycomposition ranging from about 30% to about 35% and the chitosancomponent comprising about 3% of the carrier solution with the chitosanhaving a molecular weight ranging from about 1.0×10³ to 3.0×10⁵ Daltons.25. A malleable bone putty composition as claimed in claim 24 whereinthe carrier formulation includes a sodium phosphate buffer of about pH7.2.
 26. A malleable bone putty composition as claimed in claim 24wherein said carrier solution includes saline water.
 27. A malleablebone putty composition as claimed in claim 24 wherein said carriersolution includes sterile water.
 28. A malleable bone gel compositionfor application to a bone defect site to promote new bone growth at thesite which comprises a new bone growth inducing amount of demineralizedlyophilized allograft bone powder with a particle size ranging fromabout 250 to about 850 microns in a high molecular weight hyaluronicacid in water carrier with the hyaluronic acid component comprisingabout 1% of the carrier and having a molecular weight over 1.0×10⁶Daltons, the bone powder content of the compositions ranging from about25% to about 30%.
 29. A malleable bone gel composition for applicationto a bone defect site to promote new bone growth at the site comprisinga new bone growth inducing amount of demineralized lyophilized allograftbone powder with a particle size ranging from about 250 to about 420microns mixed in a high molecular weight hyaluronic acid water solutioncarrier with the hyaluronic acid component being present in the amountof about 1% of the carrier and having a viscosity of about 1,800 to13,000 cps, the bone powder amount content of the composition rangingfrom about 25% to about 30% by weight.